- New research shows that self-managed medication abortion offered via telemedicine is safe and effective.
- The study adds to a large body of evidence supporting the safety and efficacy of the telemedicine procedure, which includes virtual visits with a provider who prescribes abortion pills by mail.
- The U.S. Supreme Court will soon decide whether to restrict access to the abortion pill mifepristone.
The U.S. Supreme Court will hear the case against the abortion pill mifepristone on March 26. Their decision could have a major impact on the ability of people to safely and easily access medication abortion.
The hearing follows a 2023 ruling by the U.S. Court of Appeals for the 5th Circuit that challenged the U.S. Food and Drug Administration’s (FDA) authority on the abortion pill, which has been reviewed and evaluated for safety for more than two decades.
If the justices rule against the FDA, it could significantly restrict access to the medication.
Medication abortion accounts for more than half of all abortions. The procedure, which involves taking mifepristone followed by another medication, misoprostol, is safe and effective.
Should mifepristone be restricted, medication abortion can still be done via misoprostol, according to recent studies. However, experts say that this version of medication abortion may be less effective.
Medication abortion is extremely effective and safe
A substantial body of research supports the safety and effectiveness of self-managed medication abortion, whether the procedure is performed in person or remotely via telehealth.
Now, researchers from the University of California San Francisco have found more evidence supporting telehealth abortion as a safe and effective way to terminate pregnancy.
The national study, published in Nature Medicine on Thursday, has been cited in a brief submitted to the Supreme Court in advance of the hearing. The research is backed by more than 300 reproductive health researchers, according to a news release.
“We believe this study has huge implications for policy, in particular for the upcoming Supreme Court case on mifepristone (one of two medications used in medication abortion). This research shows that the FDA followed science when it expanded how this medication could be dispensed and that the Supreme Court should follow suit,” lead study author Dr. Ushma Upadhyay, professor of Obstetrics, Gynecology & Reproductive Sciences at UCSF, told Healthline.
Telehealth abortion is as safe and effective as seeing a physician
For the study, researchers looked at medical records for more than 6,000 people prescribed abortion pills from telehealth clinics in 20 states and Washington D.C. from April 2021 to January 2022.
They determined no adverse events were reported 99.8% of the time, and 98% of the time, people who had abortions did not require follow-up care.
These findings present similar success rates to patients who obtained abortions in person at clinics or doctor’s offices, the study authors noted.
Telehealth abortions may involve video visits and secure text messaging with a healthcare provider, who sends prescribed abortion pills by mail and may engage in virtual follow-up visits.
“As with any other medical visit via telehealth, the physician takes a history and relevant physical exam, reviews lab results and ultrasounds, and evaluates for any contraindications to medication abortion before administering the mifepristone pill,” explained Dr. Lydia Prevost, a family medicine physician who provides abortion care via telehealth in Kansas and Fellow with Physicians for Reproductive Health.
Dr. Sarah W. Prager, a professor in the Department of Obstetrics and Gynecology at the University of Washington School of Medicine, said the UCSF study supports all the previous data and “unequivocally shows that medication abortion is safe and effective.”
“It doesn’t matter whether the medications are dispensed by a clinician after an in-person visit or through a virtual clinic — mifepristone and misoprostol are safe and effective,” Prager told Healthline.
“These data further underscore the reasons why mifepristone should stay available — without any of the REMS restrictions — and highlight that all the restrictions (both to mifepristone and to abortion more broadly) are political and serve only to harm pregnant people.”
Researchers also noted that telehealth abortion makes the procedure more accessible while protecting patient privacy, a growing concern in states with abortion bans and restrictions.
“Telehealth addresses some of the geographic, transportation, and other resource-related barriers that we know have always gotten in the way of patients accessing abortion care, but especially in the months since Dobbs,” Prevost noted, referencing the legal decision in Dobbs v. Jackson Women’s Health Organization that overturned Roe v. Wade
“Medication abortion using mifepristone and misoprostol is a great option for many people needing abortion care. The education that patients need to be informed about their decision and instructions on how to take the medications can be done just as safely and effectively via telehealth as in person,” she told Healthline.
What happens if the abortion pill is banned?
Abortion has been banned or had additional restrictions added in 21 states following the Supreme Court’s June 2022 decision to overturn Roe v. Wade. Another three states have had restrictions on abortion blocked in courts.
Demand for abortion pills prescribed via telehealth has increased as abortion clinics have closed in states with bans and other restrictions. In states where abortion may be permitted, long wait times at clinics stretch for weeks, some with no availability at all.
If the Supreme Court decides to ban the abortion pill mifepristone, it could severely limit access to the medication. A mifepristone ban would block telehealth prescriptions and shipments of the medication by mail, creating additional barriers in states where people seeking to end a pregnancy already face mounting hurdles.
“If the Supreme Court rules to reinstate further restrictions to mifepristone, not only would it be ignoring all the credible scientific data available, it would also significantly increase the barriers to accessing abortion, which will increase morbidity and mortality for pregnant people,” Prager said.
While misoprostol alone can work to safely terminate pregnancy, experts have cautioned it may not be as effective as when combined with mifepristone.
“The combination of mifepristone and misoprostol is the current standard of care for medication abortion care,” Prevost said. “While other regimens like misoprostol-only do exist and are also safe, medications with proven safety records like mifepristone should stop being targeted because of political beliefs.”
Takeaway
As the Supreme Court decides whether to ban the abortion pill mifepristone and limit access to telehealth abortion, a large national study has demonstrated the safety and effectiveness of self-managed abortion via telemedicine.
Medication abortion can be safely delivered through telemedicine via video visits, secure text messaging, and mailing prescribed abortion pills.
The new research adds to a substantial body of evidence demonstrating the safety of self-managed medication abortion.
“Telehealth has been growing exponentially in many fields of medicine particularly since the pandemic, and we have good data to show that it is safe and effective,” Prevost said.
